today please visit over at brainblogger, where i talk about research on how some psychologists view people with mental health issues, especially those with schizophrenia and borderline personality disorder. interesting points that are being discussed in the comments are the place of diagnosis and the importance, or limits of, of objectivity.
the other day i received a phone call from william (not his real name), very distressed. he was in the psych ward, on his third week now. “i gotta get better, i gotta get better!” he kept saying. his hospitalization had been preceded by a good six weeks of progressively worsening mental health. anxiety, depression and borderline personality disorder were only some of the diagnoses that had been with him for many years. when he is healthy, he is funny and quirky, a dedicated stay-at-home dad who enthusiastically shares his two daughters’ passion with field hockey. when he cycles into his illness, his thought patterns quickly become more and more one-dimensional until all that is left is a looming preoccupation with how bad of a father he is and a clinginess that becomes almost unbearable to his partner, especially since it tends to be laced with hurtful sarcasm.
my involvement with william is only at the margins. when things get bad, though, we often spend a lot of time on the phone. he finds our phone calls comforting; i think it’s because i treat him like a normal human being, because i, too, have personal experience with mental illness, and also because i keep pointing out my boundaries, gently but firmly.
when william called and kept saying, “i gotta get better, i gotta get better”, my instinct made me blurt out, “you gotta make a choice here. either force yourself to get better – the old pull-yourself-up-by-the-bootstraps method – or accept that you’re sick right now, and that this could be a slow process. but if you keep going back and forth between the two, it’s going to drive you around the bend.”
in my observation, one of william’s major problem seems to be that he is stuck in a painful, very tight loop of thoughts and feelings, a cage of unrelenting self-talk of self-loathing, control and neediness (“i’m a failure!” “no-one wants to spend time with me!” “jean bought the wrong kind of potatoes again!”) my blurting and telling him what i think he needs to do – not exactly according to the textbook of counselling – was at least partially informed by this observation. perhaps i was trying to say, “get out of your cage!”
over to you, readers. what do you think? was my exclamation to make a choice clumsy, too directive? if you were william, how would you have reacted? would you feel connected because i simply followed my instinct and therefore related on a real level?
i just finished reading norm amundson’s new book metaphor making. it is written to assist counsellors in making better use of metaphors and includes theoretical foundations and intervention exercises. the most interesting part (for me) were the forty metaphoric images that offer an in-depth practical and personal opportunity to experience working with metaphors. i’d like to give you a taste of it. this one is about the yellow brick road. since i’m thinking of using it with my immigrant clients who may not be familiar with the wizard of oz, and since some of you may have forgotten the story, here’s a short intro, adapted from amundson’s version:
once upon a time there was a young girl, dorothy, and her dog, toto.
one day they were swept away by a cyclone and carried away to the land of oz. dorothy was determined to get back home and found out she should get help from the wizard who lived in the emerald city.
on her journey there, she was joined by three companions: a lion who needed courage, a scarecrow who needed a brain, and a tin man who needed a heart. the foursome met traveled on a road paved with yellow bricks and they met many adventures, and good and bad witches.
in the end they found the wizard and it turned out he was no real wizard after all! still, they managed to reach their goals through the magical encounters they had had along the way.
amundson’s thoughts on this story:
sometimes we are unexpectedly blown away by strong winds that knock us off the ground and take us to new places. when that happens, we get confused and we have to create new plans.
in the story dorothy has silver slippers that have the power to take her home but she does not know that. instead she goes on a journey to get help from an expert who, it seems, has all the answers.
dorothy’s companions all have lost confidence in their natural abilities. together they represent passion, intellect and the courage to act – all essential elements of a happy life. they, too, are seeking to find help from the wizard.
when we are in transition (“on the road”) we often feel uncertain. there can be confusion and doubt that we are smart (the scarecrow’s missing brain) or emotionally strong enough (the tin man’s missing heart). we can feel fear, and that can take away from our courage to take risks (just like the lion).
still, it all gets resolved because of persistence, problem solving and help that comes in the midst of all the difficulties – often from unexpected sources.
the wizard in this story has maintained power through lies and illusion. maybe that’s similar to some job seekers who feel that there are negative forces that exert control over them (e.g. a bad economy). in the end, the wizard is unmasked. however, no-one kills or punishes him – he only is allowed to show his true, human face now – and it turns out that without his mask, he also can be helpful.
the answers for many of life’s problems lie within us rather than in the hands of an all-knowing expert. there are also many ways in which people can support each other to reach their goals.
things to think about:
can you see any similarities between your situation and the story of the wizard of oz?
can you see some areas of your life where you may have more strengths than you are using right now?
if you were in this story, what would you be looking for: courage, passion, intelligence, a home – or something completely different?
can you think of another story that might have similarities with your situation right now?
my brain is still only functioning at 42.718% capacity (as opposed to the usual 60 7/8th) so i don’t find myself to be able to say much. what little brain power i had went to work today and another fabulous mental health chat on twitter. but i feel guilty for not blogging enough so i thought i’d show you what blog posts i’ve liked today in my google reader. i’ll even do the shocking thing and not convert everything into lower case! here we go:
I was alerted by Nathan Tippe to the 5 Days Vancouver campaign, the local branch of the national 5 Days campaign, created by students to raise awareness of the situation of homeless people and at-risk youth. I was more than happy to promote the cause (a) because it is a fundraiser and (b) because the local chapter is being organized by UBC students (and as you know, I teach at UBC).
A March 15th news release from the Mental Health Commission of Canada:
CALGARY, March 15 /CNW Telbec/ – Statistics Canada is predicting that 1 in 3 Canadians will belong to a visible minority by 2031. The Mental Health Commission of Canada has released a report addressing the needs of multicultural, immigrant and refugee groups. The study is part of its mandate to improve mental healthcare across all areas of Canadian society.
from PsyBlog by Jeremy Dean
Which of these would you say sounds like the more dangerous food additive: Hnegripitrom or Magnalroxate?
The majority of people say Hnegripitrom sounds more dangerous. It turns out that the word ‘Magnalroxate’ is easier to think about than ‘Hnegripitrom’, probably because it’s more pronounceable, and people equate simplicity with safety (actually both words are made up).
This is one example of psychological research on meta-cognition: thoughts about other thoughts. Whether or not something is easy to think about”cognitive fluency”is one important type of meta-cognition, with all sorts of benefits accruing to things that are easily processed.
Here are 8 of my favourite studies on cognitive fluency, showing just how much can be explained by the feeling that something is easy to think about (or otherwise).
1. Complex writing makes you look stupid
Many of us did it in school: tried to impress teachers with fancy language and convoluted sentences, assuming it would make us look clever. As we soon discovered, though, most people can’t carry it off.
This has been tested by a study that manipulated text complexity to see how readers would judge the author’s intelligence. It found that as the text became more complicated, readers gave lower estimates of the author’s intelligence (Oppenheimer, 2005).
So if you want to be perceived as more intelligent (and who doesn’t?) keep your writing simple. This chimes perfectly with the standard advice given to wannabe writers. Sadly simplicity can be a lot harder to achieve than complexity.
(Note: the context of this study was students judging other students’ essays. This study might not extend to other types of writing and other types of readers.)
This will be my fourth week on the road; more on that later in the week. At least all that plane time (and waiting in lines time) makes for good reading time”thanks to the iPhone Kindle Reader app. (and no they don’t pay me for saying it).
I’m re-reading Francis Fukuyama’s 1995 classic Trust: the Social Virtues and the Creation of Prosperity.
It’s the perfect companion for Andrew Ross Sorkin’s Too Big to Fail: The Inside Story of How Wall Street and Washington Fought to Save the Financial System”and Themselves.
Fukuyama’s View of Trust
Fukuyama makes a compelling case that economic development is strongly affected by the cultural norms of a society”in particular, the propensity to trust. In this, he is up against both neo-classical economists (who argue people are rational utility-maximizers), Marxians (who argue it’s all about the money), and a ton of management theorists (who pretty much believe both).
The Chinese, Korean and Italian preference for family, Japanese attitudes toward adoption of non-kin, the French reluctance to enter into face-to-face relationships, the German emphasis on training, the sectarian temper of American social life: all come about as the result not of rational calculation but from inherited ethical habit.
Who we trust, it turns out, radically determines the nature of business we engage in.
One of the most striking features of those suffering from anorexia nervosa is their perception of their bodies. You can put them in front of a mirror and they will still tell you they’re to fat when in fact they’re skinny. A recent publication in Nature Proceedings has an explanation.
This explanation is based on the fact that our spatial experience is based on the integration of two different kinds of input, two different sensory inputs within two reference frames. These two reference frames are the egocentric frame and the allocentric frame.
With the allocentric frame you can “see yourself engaged in the event as an observer would”, it’s the observer mode, you can see your self in the situation. This allocentric representation involves long term spatial memory mostly located in the hippocampus and the surrounding medial temporal lobes of the brain.
unhealthy habits and demographic changes are combining to place an unprecedented burden on the health-care system that may not be manageable, the heart and stroke foundation said in its 2010 annual report on canadians’ health.
so says the CBC about an alarming increase in heart disease and the potential for heart disease, adding `most of this is preventable.” the solution is
encouraging canadians to be more physically active, eat a healthy diet and be aware of their risk factors for heart disease.
“we all eat from stress, or because we don’t have time to prepare things,” said cheryl shapiro, a heart patient in toronto who was diagnosed with high blood pressure eight years ago.
she encourages people to read labels. “we don’t realize what we’re putting in our bodies.”
it is difficult to fit in the recommended minimum of 30 minutes of moderate-intensity exercise at least three times a week, shapiro said, but she does walk her dog regularly.
part of the solution is to create infrastructure to make it easier for people to walk to the store rather than driving everywhere to avoid exercise, abramson said.
“it’s easy to take shortcuts,” abramson said. “but in the long run, those shortcuts will be disastrous for our health.
there was a bit more about this on the radio but the gist was the same. what i found interesting – always find interesting about such news stories – is that obesity and being overweight is almost exclusively seen as a lifestyle choice. the equation of overweight = fat = out of control, unattractive, lazy, weak-willed etc. is not made explicitly but it’s really just three letters away. indeed, when i looked at the first five or six pages of the comments, i saw the word “lazy” six times. neither in the story nor in the comment pages did i see the word “eating disorder” or “addiction”.
i often get the feeling that in the world of psychiatric diagnoses, anorexia is much more noble than overeating. the overly thin person who uses her will power to deny herself a piece of broccoli is so much more appealing in our culture than the slob who sits in front of his TV, gobbling ice cream. of course both are caricatures and tell only a very, very thin slice of reality (for example, you could have two very similar looking people side by side, one of them struggling with undereating, the other with overeating. it doesn’t always show in the body size.)
there is controversy in the psych community over whether overeating is an addiction. i must say that i find NEDIC‘s approach in can i be addicted to food? just as naive as the above article. it ends up saying “once we begin eating in a normal, healthy way again, we won’t have the same desire to eat as much high-calorie, high-carbohydrate food, or foods we think are “bad”.” that sounds really easy, doesn’t it?
now of course “addiction” is just a label, so let’s not split hairs here (although personally i am firmly on the side of gabor mate’s definition of addiction, which would agree with the use of the word in connection with overeating). rather, let’s be clear on this:
there are many people who eat much more than they want to and are unhappy about it. they try and try and try and nothing seems to work. they experience things like this: they cry during binges because they hate that they are eating non-stop. they go to bed night after night with terrible stomach pains because they have eaten too much. they eat out of garbage bins, eat frozen and spoiled food. they go to great pains to hide their eating from others, often ordering nothing but a little salad when they go out with others. they go from macdonald’s to burger king to wendy’s, pretending they are buying for a family. they spend thousands of dollars on diets that work for a while and then go back to bingeing. they commit suicide over the shame they feel over their out-of-control eating.
this is not a little lifestyle problem that will go away with a bit of education and an admonishment to use more willpower. many people who overeat know a lot about nutrition already and know they should exercise more, just like many people who smoke know what their lungs look like. they are deeply unhappy that willpower doesn’t seem to work. my best friend’s mother, an astonishingly intelligent woman, died of lung cancer, greedily sucking on a cigarette just before she went into her last coma. while not every person who is overweight suffers with such intensity, there are nevertheless similarities. overeating, for many, is a disfiguring, depressing, despairing dis-ease that is difficult to fight. i wish that this will be acknowledged more in the coming years. come to think of it, MentalHealthCamp, our second conference on the intersection between social media and mental health, will be a great way to address this.
(this is another post for national eating disorders week)
the CMHA (vancouver-burnaby branch) will be holding a depression and anxiety screening the evening of monday, january 18th 2010, which they call ‘blue monday.’ blue monday is traditionally the third monday in january, a date chosen because it occurs after the holidays but when the days are still dark and dreary, new year’s resolutions may have already been abandoned, post-holiday bills are coming in, and it will be a few more months until another holiday occurs. as a result, people may be feeling sad and overwhelmed. blue monday is therefore an excellent opportunity to take stock of one’s mental health, to acknowledge when things are tough, and take steps to improve it.
participants fill out a depression or anxiety questionnaire, which is then scored anonymously by volunteers. the participant then discusses the results with a clinician, who will make suggestions based on the results. this is not meant to be a counselling session, but an opportunity to have participants think about their mental health, and see their own medical doctor if there is reason to believe s/he should.
the blue monday depression and anxiety screening will take place between 5 and 8 p.m. on january 18th, 2010. space is limited, so interested individuals are asked to register in advance by calling 604-872-4902 or contacting email@example.com.
the CMHA will also have information and resources on mental wellness, and will be showing a series of films by award-winning film-maker, gary ledbetter.
my vancouver blogger friend jonathan narvey has a discussion about the current allegations that the canadian military looked the other way when people they had detained in afghanistan were transferred to afghani prisons where the canadian military knew, or should have known, that the detainees would be tortured. please see jonathan’s article and various comments, including two from myself, here.
among others, jonathan referred to the taliban as “our enemies.” to that i said:
they are not OUR enemies. they are the enemies of a country in dire need of peace and democracy. our enemies, as the enemies of the world all over, are despotism, poverty, fanaticism, lack of education, misogyny and war.
jonathan replied that
our enemies are more than conceptual
i’d like to use this space to think about this a bit.
“the problem is the problem. people are not the problem” is one tenet frequently cited in psychology, in various forms (e.g. “i like you but not your behaviour XYZ.”)
so i see three things right now:
1. if we want to move away from the conceptual then we have to admit that “enemies” refers to people. who are these people? THE taliban? (or in the past, THE russians, THE germans, etc.) “the” taliban is a movement – a vague word if there ever was one – comprised of people from afghanistan and pakistan as well as uzbekistan, chechnya, etc. what we know about movements, especially authoritarian ones, is that the vast majority of people involved in them became members not because of sober decisionmaking but because of necessity, sentimentality (e.g. misunderstood religiosity/fanaticism), coercion or other unsavoury reasons. is the 13-year-old hero-worshipping boy our enemy? the father of 9 children who doesn’t know how to feed them? the grandfather who was told in no uncertain ways that he needs to join or else?
no, “the” taliban are not my enemies.
2. in fact, the word “enemy” does not work for me. as soon as i have an enemy, i give myself permission to treat her or him as unworthy of living. “the enemy” is not my problem.
3. but i agree that abstract concepts are not useful either.
so why don’t we say it like that:
people who rape, maltreat, murder, beat, torture, subjugate and commit other crimes need to be stopped and measures need to be put in place to prevent them from committing more crimes – through rehabilitation, incarceration or a combination of them. (not through torture)
some of these people are in afghanistan. not all of them. some of them are taliban. not all of them.
i am grateful that our military is trying to deal with the people who literally commit crimes against humanity. it’s a very difficult job. in all difficult jobs, mistakes are made. i think it’s possible that one of the mistakes was to hand over detainees to prisons where torture was commonplace. we need to look at that because if we don’t we, too, commit an act of criminal negligence.
a little while ago, a paper was published that suggests that positive thinking isn’t all it’s cracked up to be:
positive self-statements are widely believed to boost mood and self-esteem, yet their effectiveness has not been demonstrated. we examined the contrary prediction that positive self-statements can be ineffective or even harmful. a survey study conï¬rmed that people often use positive self-statements and believe them to be effective.
two experiments showed that among participants with low self-esteem, those who repeated a positive self-statement (”i’m a lovable person”) or who focused on how that statement was true felt worse than those who did not repeat the statement or who focused on how it was both true and not true.
among participants with high self-esteem, those who repeated the statement or focused on how it was true felt better than those who did not, but to a limited degree. repeating positive self-statements may beneï¬t certain people, but backï¬re for the very people who ”need” them the most.
ray at the affirmation spot has an interesting discussion of this. let me add a few more thoughts.
as ray points out, it looks like the researchers didn’t quite know how affirmations are best used (and i think that ray’s suggestion of how the research might be conducted next time are fabulous). unfortunately, this happens more than occasionally in social science research. from what i can tell, that can come from a) truly not having a good understanding of the research subject and b) some of the traditional methodologies in social science research.
as for a), my husband, an avid poker player, often complains about that. he is very interested in psychology and enjoys participating in poker-related research. almost all of the time, however, he finds that psychologists who research poker have little understanding of the game, not appreciating, for example, that many serious poker players don’t approach it as a game of chance (like roulette, for example) but as a game of skill. consequently, the researchers ask questions that are irrelevant to these serious poker players and therefore end up with irrelevant results. i wonder whether that was similar in the research ray talks about.
regarding methodologies used, we need to keep in mind that experimental research as it traditionally carried out needs to be tightly controlled, which means that the more variables are introduced into an experiment, the less control there is possible – which in turn means that researchers like to have as few variables as possible (i.e. they just use one question). there are some good uses of experimental research – the famous pavlovian dog, for instance, has spawned some truly remarkable work – but experimental research also has its limits. perhaps using this methodology was not the best one for the topic of affirmations. that, of course, poses a problem – experimental research is often seen as the only methodology that will give reliable results.
on the other hand, i think it’s important that these topics are taken under the microscope of research and science. i would not be sitting here on this laptop that is a hundred times faster than the first million-dollar computer i ever worked with if it was not for science, and you wouldn’t be reading it on your iPhone or on facebook. science is a great treasure. the argument “affirmations have worked for me, so this research is bogus” is not – not, not, not – valid. qualitative experimental research is about statistics and probabilities and the question is not, “did/do/will affirmations work for joe?” but, “for how many of these 100 people did affirmations work, and does this give us reason to believe that they will work for an equal percentage of a given population in the future?”
in the end, we need to figure out how we would like to use this research. if affirmations have worked for you and perhaps also your clients, great. you can just look at this research and say, “hm, interesting, doesn’t seem to apply to me.” on the other hand, if you have found that affirmations haven’t always delivered what you had hoped, perhaps this research has a clue to what’s going on. note the “perhaps”. that’s what research and other sources of knowledge (and maybe even wisdom) are – little pieces of a puzzle that sometimes but not always show us the way to a bit more understanding.